Persons with comorbid chronic diseases experience a wide range of barriers to self-care, including several that are specifically related to having multiple medical conditions. Self-management interventions may need to address interactions between chronic conditions as well as skills necessary to care for individual diseases.

These respondents describe an ideal process of care that is patient centered and individualized and that supports their unique constellations of problems, shifting priorities and multidimensional decision making. Individual and ongoing care coordination managed by a primary contact person may meet some of these needs. Achieving these goals will require developing efficient methods of assessing patient care needs and flexible care management support systems that can respond to patients' needs for different levels of support at different times.

Few studies have examined the impact of cancer on the survivor's quality of work life. The purpose of this qualitative study is to describe the work experiences among a diverse group of cancer survivors and to explore factors influencing decisions about work after cancer diagnosis and treatment. We interviewed 28 participants with a broad range of socioeconomic backgrounds and primary cancer sites. Qualitative results indicate that after learning about their cancer diagnosis, participants had diverse and complex patterns of work return and work change, and experienced a variety of factors that influenced post-cancer decisions. Experiences at work after cancer also varied in relation to how others responded, changes in productivity, effects of cancer and treatment on work, and feelings about work. Most respondents received little guidance from their physicians about work, and many participants described their cancer as impacting their priority of work relative to other aspects of their lives. Our findings reinforce the complexity of measuring employment outcomes and the range of adaptations made to improve the quality of work life. Additional research is needed to identify prognostic factors that can guide clinical or workplace efforts to restore cancer survivors to their desired level of work function and economic productivity.

C ancer survivorship research seeks to improve the physical, psychosocial, and economic outcomes of individuals who have a history of cancer. 1 For working-age adults with cancer, work impairment may be one of the most burdensome consequences of cancer. Inability to return to work after cancer treatment, frequent or prolonged work absenteeism, or problems with work performance may have substantial economic impact on the survivor and her or his family. [2][3][4][5] Changes in work also may have substantial impact on self-esteem, quality of life, and social or family roles. 6 -10 Finally, work performance after cancer treatment may be a measure of recovery in its own right.Despite its importance, the impact of cancer and its treatment on work has been studied infrequently. Spelten and colleagues reviewed the literature through 1999 and concluded that critical questions, such as the impact of different cancer sites on work and the extent of racial or socioeconomic disparities in work function after cancer, have rarely been addressed. 11 Furthermore, the existing literature rarely has identified remediable targets for intervention and has lacked rigorously tested intervention strategies to increase return to work or work function.More and better research on the work impact of cancer is necessary to inform the decisions of cancer survivors and their treatment providers. In this commentary, we examine the characteristics of research studies that may advance our understanding of this important clinical and social issue. To achieve this objective, we identify six methodologic attributes that provide the solid scientific knowledge necessary to inform interventions, evaluate existing studies in the light of these criteria, and propose a conceptual model to guide future research.

Influential and sustained mentorship enhances the research activity of primary care fellows. Research training programs should develop and support their mentors to ensure that they assume this critical role.